CT Images Of Thorax Research Articles

Accurate diagnosis of COVID-19 from lung CT images using transfer learning.

In this study, it is aimed to classify data by feature extraction from tomographic images for the diagnosis of COVID-19 using image processing and transfer learning. In the proposed study, CT images are made better detectable by artificial intelligence through preliminary processes such as masking and segmentation. Then, the number of data was increased by applying data augmentation. The size of the dataset contains a large number of images in numerical terms. Therefore, the results of the models are more reliable. The dataset is split into 70% training and 30% testing. In this way, different features of the applied models were found, and positive effects were achieved on the result. Transfer Learning was used to reduce training times and further increase the success rate. To find the best method, many different pre-trained Transfer Learning models have been tried and compared with many different studies. A total of 8,354 images were used in the research. Of these, 2,695 consist of COVID-19 patients and the remaining healthy chest tomography images. All of these images were given to the models through masking and segmentation processes. As a result of the experimental evaluation, the best model was determined to be ResNet-50 and the highest results were found (accuracy 95.7%, precision 94.7%, recall 99.2%, specificity 88.3%, F1 score 96.9%, ROC-AUC score 97%). The presence of a COVID-19 lesion in the images was identified with high accuracy and recall rate using the transfer learning model we developed using thorax CT images. This outcome demonstrates that the strategy will speed up the diagnosis of COVID-19.

The Relationship Between Breast Volume and Thoracic Kyphosis Angle

Objective: It has been hypothesized that a disproportionate upper body weight caused by macromastia places abnormal stress on the spine, which may lead to skeletal abnormalities. To evaluate whether there is a relationship between breast volume and the thoracic kyphosis angle measured on thorax CT images. Methods: A total of 448 female patients who underwent thoracic CT examinations were included in this study. Breast volume [ml], by using the "organ segmentation method"; thoracic kyphosis angles by using Cobb's method were made manually on the workstation. Results: Mean right breast volume was 902.03 ± 376.47 (154.21 - 2366.20 ml), left breast volume was 911.01 ± 383.34 (167.93 - 2894.07 ml), total breast volume was 1810.09 ± 750.82 (354.39 - 5100.68 ml). The total breast volume (p<0.001) and thoracic kyphosis angle (p=0.012)in patients aged 50-69 years were significantly higher than those aged 17-29 years. Larger total breast volume [p<0.001] and thoracic kyphosis angle (p<0.001) values were associated with larger BMI intervals. A significant positive correlation was observed between the total breast volume and thoracic kyphosis angle (r=0.771, p<0.001). Conclusion: Our results showed that the thoracic kyphosis angle significantly increased in parallel with a larger total breast volume, and that total breast volume was an independent risk factor for thoracic kyphosis angle. The manual organ segmentation method we used was found to be reliable and easy to apply, but time-consuming technique for calculating BV.

Peripheral and central olfactory measurements in Chronic Obstructive Pulmonary Disease patients

Abstract OBJECTIVES. We investigated peripheric and central olfactory pathways on MRI in Chronic Obstructive Pulmonary Disease (COPD) patients and the relationship between olfactory measurements of COPD patients and thorax CT images of emphysema classification in them. MATERIAL AND METHODS. In this retrospective study, cranial MRI of 42 adult patients with COPD and 42 healthy adults without COPD were included. In both groups, peripheral (olfactory bulb (OB) volume and olfactory sulcus (OS) depth) and central olfactory areas (insular gyrus and corpus amygdala areas) were evaluated. We classified thorax CT findings according to emphysema by size as 1 to 4. RESULTS. In the present study, left OB volume of the COPD group was significantly lower than that in the control group (p<0.05). On the right side, there were no significant differences between OB volumes of the COPD and control groups. Although right OB volume values were found to decrease proportionally, they were not found to be statistically significant. Also, insular gyrus and corpus amygdala areas of the COPD group were significantly lower than those in the control group, bilaterally (p<0.05). OS depths of the COPD group were significantly higher than those in the control group, bilaterally (p<0.05). In males, the right OB volume values were higher than those in females (p<0.05). CONCLUSION. In COPD patients, left OB volumes decrease and OS depths increase bilaterally, and central areas decrease bilaterally, regardless of the thoracic emphysema classification. It may be related to hypoxemia that causes airway inflammation; inflammatory mediators may be harmful to the olfactory neuroepithelium.

Apical fibrosis was the most common incidental pulmonary finding in a familial Mediterranean fever cohort.

Familial Mediterranean fever (FMF) is one of the common autoinflammatory diseases with multisystemic manifestation. Pleuritis is the only known pulmonary involvement of FMF; however, as far as we know, thoracic involvements in pleural, parenchymal, bronchial, and vascular structures have not been evaluated yet. We included 243 consecutive FMF patients who applied to our clinic within the last 5 years and were requested to have a thorax CT for any reason and 122 trauma patients without any comorbidity. An experienced radiologist evaluated the thorax CT images blindly according to the relevant guidelines. We then presented the common incidental pulmonary and mediastinal findings on the thorax CT. Additionally, we compared patients with and without lung involvement according to demographic and disease-related parameters. In our study, 167 of 243 patients (68.7%) had at least one of the pulmonary findings on their thorax CT. The most common pulmonary findings were apical fibrosis in 96 (39.5%) patients, parenchymal fibrotic changes in 48 (19.8%) patients, and a solitary parenchymal nodule smaller than 4 mm in 33 (13.6%) patients. All demographic, genetic, and disease-related characteristics, including the frequency of spondyloarthropathy, were similar in patients with and without pulmonary findings. We showed that the most common incidental pulmonary finding in our FMF cohort was apical fibrosis on thoracic CT. Our data did not show causality between FMF and apical fibrosis; therefore, more studies are needed to evaluate the frequency and clinical significance of apical fibrosis in FMF. Key Points • More than two-thirds of familial Mediterranean fever (FMF) patients in our study group who underwent a thoracic scan for any reason had pulmonary and mediastinal findings on thorax computed tomography (CT). • In our FMF cohort, the most common incidental pulmonary finding on their thorax CT was apical fibrosis. • All demographic and disease-related characteristics, including the frequency of spondyloarthritis, were similar between patients with and without pulmonary and mediastinal findings.

Clinical comparison of omicron and delta variants in older COVID-19 patients and the effect of vaccination status

Aim: It was aimed to investigate the clinical course of the Omicron vand Delta variant among the SARS-CoV-2 vaccinated and unvaccinated COVID-19 patients over 65 years old and to compare their effects on patients.
 Material and Method: The study was conducted on 567 COVID-19 patients over 65 years old. All patients’ gender, age, medical history, COVID-19 PCR test results, blood test results, thorax CT images, vaccination status, hospitalization status, and treatment results were recorded. When evaluating the chest CT images, a semiquantitative scoring system was used. The patients were divided into the Omicron and Delta variant subgroups, and vaccinated and unvaccinated groups. Comparisons were made between the Delta variant and Omicron variant groups, the vaccinated and unvaccinated patient groups,and SARS-CoV-2 mRNA vaccinated and inactivated SARS-CoV-2 vaccinated patient groups.
 Results: A total of 519 patients were included in the study.337 patients were in the Omicron variant group, 182 were in the Delta variant group.The hospitalization rate, ICU admission rate, mortality rate, rate of symptomatic patients,and the median thorax CT severity score was significantly higher in the Delta variant group than the Omicron variant group.The hospitalization rate, ICU admission rate, mortality rate, median thorax CT score and the rate of asymptomatic patients was significantly higher in the unvaccinated patient group than in the vaccinated group.There was no significant difference in the mortality rates and in the ICU admission rates between the inactivated SARS-CoV-2 vaccinated group and the SARS-CoV-2 mRNA vaccinated group.
 Conclusion: The SARS-CoV-2 Omicron variant compared to the Delta variant and the SARS-CoV-2 vaccinated patients compared to the unvaccinated patients had a milder clinical course and less mortality in COVID-19 patients over 65 years old.

Hemogram Parametreleri SARS CoV-2 Enfeksiyonunda Geniş Pulmoner Tutulumu Öngörebilir mi?

Aim: Since the start of the pandemic, the novel coronavirus infection SARS CoV-2 has caused huge morbidity and mortality, as well as a significant economic cost. We aimed to compare clinical and laboratory findings of the SARS CoV-2 patients with mild pulmonary involvement to those in subjects with advanced pulmonary involvement.
 Material and Methods: In this study, the relationship between hemogram indices and pulmonary involvement in patients hospitalized for SARS CoV-2 infection at Bolu Abant Izzet Baysal University Hospital was investigated. We analyzed the thorax CT images of the subjects with SARS CoV-2 in present retrospective study. Radiological pattern of disease-related in the lungs, percentage of lung involvement, hemogram parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), aspartate and alanine transaminases (AST and ALT), lactate dehydrogenase (LDH), D-dimer, ferritin, total bilirubin, albumin, creatinine kinase, serum creatinine in patients with advanced and mild pulmonary involvement were compared. 
 Results: Advanced pulmonary involvement (greater than 50%) was positively and significantly correlated with ESR, (r=0.32, p

Treatment of COVID-19 Patients: Insights into the Use of Bone Marrow-Derived Mesenchymal Stem Cells

Patients with SARS-CoV-2 may be affected by the acute respiratory distress syndrome (ARDS), which has been associated with high mortality rate. As no specific drugs are available for ARDS, mesenchymal stem cells (MSC) seems to be a promising cell therapy due to immunomodulatory effects on reducing and healing inflammation-induced lung and other tissue injuries. The goal of this Phase I clinical trial was to explore the safety and efficacy of bone marrow-derived MSC (BM-MSC) infusions in patients with COVID-19 ARDS. The inclusions criteria were age between 18 to 70 years and PaO2/FiO2≤200mmHg. The BM-MSC infusions were as follow: one to 3 infusions intravenous doses of BM-MSC of 1x10 6 cells/kg; each dose could be administered with an interval between 3 to 7 days. The primary endpoint was safety (adverse events) within 6 hours; cardiac arrest or death within 24 hours post-infusion. The secondary endpoint includes patient survival at 30 days after the first infusion.Six patients were included in the trial and treated with at least one infusion of BM-MSC. The median age was 60,3 years (54 to 69), 5 were male. The median time between the worsening of respiratory distress and the BM-MSC infusion was 10 days (3 to 31 days). The median of PaO2/FiO2 before infusion was 151.86 (127.80-164.44) and median PaCO2 was 63,85 (39 to 117). One patient was treated with 3 MSC doses, two patients with 2 doses and 3 patients one dose. No serious adverse effects were observed within 24 hours post-infusion; only one death was observed following 30 days of cell administration. None of them showed adverse events during BM-MSC infusion. Only one patient showed signs of pulmonary infection one week after first BM-MSC infusion. This patient was at increased risk for infection due to prolonged intubation and a high dose of corticosteroid. Therefore, it was not possible to conclude its association with BM-MSC treatment.Only two patients showed clinical improvement after BM-MSC infusion. Patient 1 had BM-MSC infusion 72 hours after worsening of respiratory parameters, and thorax CT suggested the hypothesis of cryptogenic organizing pneumonia, which led to decision of using methylprednisolone 125mg I.V. for 3 days and carry on with MSC infusion. We observed a decrease in CRP levels from 126 to 67 mg/dL on day 1 after the first infusion, and PaO2/FiO2 ratio improved from 155 to 297 mmHg on day 5. He received the second dose within 7 days interval and by day 11 of the first infusion a new thorax TC showed complete resolution of alveolar consolidation areas in both lungs (Figure 1A and 1B). Patient 2 had BM-MSC administration 11 days after respiratory worsening and also presented improvement of PaO2/FiO2 ratio (148 to 215 mmHg after 2 days of infusion) and had thorax CT images suggesting cryptogenic organizing pneumonia with administration of methylprednisolone 250mg I.V. Nevertheless, the second dose was not administered due to ventilator-associated pneumonia and urinary infection.Four patients showed a non-sustained increase of PaO2/FiO2 ratio, with higher median PCO2 levels of 69,3 mmHg (range, 61,2 to 117) comparing to 39 and 47,3 mmHg of patients 1 and 2, respectively. PCO2 parameter could be a marker to indicate a worse response to MSC treatment, since it could point out chronic phases of COVID-19 disease. The patients died due to COVID-19 complications.No difference in inflammatory markers, such as interleukin 6, C-protein reactive test, procalcitonin, ferritin was observed before and after treatment.Inclusion criteria did not defined interval between respiratory worsening and first BM-MSC infusion. Four patients had chronic phase of COVID-19 without inflammatory markers and hypercapnia. It could be related to severity of pulmonary disease, such as reported in chronic obstructive pulmonary disease. Two patients were discharged after MSC treatment and they received methylprednisolone to treat cryptogenic organizing pneumonia. There are only a few clinical trials and observational studies evaluating the use of high-dose of glucocorticoid for severe COVID-19 pneumonia. Therefore, it is not possible to conclude that use of glucocorticoid has contributed to favorable outcomes.In conclusion, BM-MSC showed to be a secure therapeutic option for severe COVID-19 pneumonia, possibly with superior benefit in acute phases and lower PCO2 levels. Further studies involving a large cohort or randomized controlled trials are warranted. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Ability of Laboratory Findings Upon Admission to Predict Lung Involvement and Its Severity in COVID-19 Patients Requiring Hospitalization

Background: The struggle of humanity with Coronavirus disease 2019 (COVID-19) infection, which affected the whole world and caused severe social and health crises, continues without deceleration. Objectives: This study aimed to determine the relationship between the abnormal laboratory parameters upon admission and the intensity of lung involvement using chest computerized tomography severity score (CT-SS). Methods: This single-center study evaluated a total of 242 patients who were admitted to our hospital due to COVID-19 with positive polymerase chain reaction (PCR) test results. The patients were divided into three groups of no involvement on thorax CT images, mild involvement, and moderate-severe involvement. Results: The mean ages of groups 1 (n=42), 2 (n=123), and 3 (n=77) were 38±10.6, 56.3±16, and 61±15.6 years, respectively (P<0.001). The three groups showed significant differences in terms of hypertension, diabetes mellitus, heart rate, oxygen saturation, lymphocyte count, platelet-lymphocyte ratio (PLR), systemic immune inflammation index (SII), ferritin, troponin-I, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP) values (P<0.001). The CRP (R=0.545, P<0.001), ferritin (R=0.481, P<0.001), and SII (R=0.473, P<0.001) were moderately and positively correlated with CT-SS, while neutrophil-lymphocyte ratio (R=0.404, P<0.001), PLR (R=0.371, P<0.001), and ESR (R=0.327, P<0.001) were mildly and positively correlated with CT-SS. Conclusion: The results of the present study showed that elevation in CRP, as well as ferritin and SII values upon admission to the hospital was significantly correlated with CT-SS. The results also revealed that the presence of lung parenchyma involvement might be predicted in PCR positive COVID-19 patients without the need for thorax CT. Furthermore, it is believed that this information will provide great convenience to the clinicians who first welcome the patient in terms of predicting COVID-19 lung involvement.

AGE AND SEX DETERMINATION FROM THE MORPHOMETRIC CHARACTERISTICS OF THE 4TH COSTA ON MULTI-SLICE COMPUTERİZED TOMOGRAPHY

Background: The determination of sex and estimation of age are parameters that help in the identification of individuals in all fields of forensic science. The aim of this study was to calculate standard measurements according to sex and age in morphometric analysis of the 4th costa using multi-slice computed tomography (MSCT). Material and Method: Measurements were taken on MSCT images of patients aged 20-70 years, who had undergone CT imaging for various reasons. Using the morphometric characteristics of the 4th costa and junction with the spine on the thorax CT images, measurements were taken of the angulation of the right and left 4th costa, the distance between the sternum and the vertebra, the distance between the two costae, the distance between the two ends of the right and left 4th costa separately, and the depth of the two costae. Adding age and gender to these variables, 10 parameters were evaluated in total. Results: As a result of the analyses, the mean values of right costovertebral angle, sternum-vertebra distance, inter-costal distance, left and right costa lengths, and left costa depth were found to be statistically significant according to sex. In the differentiation of age groups, the right costovertebral angle, the sternum- vertebra distance, and the right and left costa lengths were found to be statistically significant. Conclusion: The results of this study of a Turkish population showed that the morphometric properties of the 4th costa show differences in the determination of age and sex. With the benefit of these differences, it is possible to differentiate males and females, and even age groups. As there are societal differences, standard morphometric values have to be determined so it will be necessary to conduct these studies more widely and obtain appropriate standard values for every population.

Evaluation of the Relationship between Ossification of Sternal Joints and Age with Multi-Slice CT Scan

Objective: Sternum radiograph is used in determination of age after 21 years old according to manubriosternalbody (MB) and xiphisternal joint body (XB) ossification. In this study, we intend to estimate age usingmulti-slice CT images as radiographs have lower sensitivity and CT images demonstrate ossification better.Materials and Methods: Multi-slice thorax CT images found in PACS archive are evaluated retrospectively.Cases between 21-65 years old are selected. Coronal reconstruction images were obtained. MB and XB jointossification presence and degree are evaluated in respective age groups. MB joint ossification is gradedas 0-3 and XB joint ossification graded as 0-1. Relation between variables is examined with Spearmancorrelation coefficient. Threshold for age variable is calculated using ROC analysis.Results: Multi-slice CT images of 396 cases are examined (198 females, 198 males). In females and males,MB and XB fusion was seen to start between age group of 21-25 years but there were complete fusion ina few. In 61-65 age groups there were cases without complete fusion. There was statistically significantdifference in males and females according to MB and XB joint ossification in between age groups (p<0.001).Conclution: Evaluation of MB and XB joint ossification with CT scan in age estimation is not appropriatebetween wide age groups.

COVID-19 patients’ sera induce epithelial mesenchymal transition in cancer cells

Covid-19 Pneumonia of SARS-CoV-2 pandemic infection, persists to have high disease burden especially in cancer patients. Increased inflammation and thromboembolic processes are blamed to influence cancer patients more than the others but due to lack of knowledge regarding the pathophysiology of the both the virus itself and the response of the host, more basic and translational disease modeling research is needed to understand Cancer-Covid-19 interaction. In this study, serum samples from the patients, who were hospitalized due to Covid-19 pneumonia, applied to different cancer cells and cytotoxicity, motility, proliferation and gene expression analysis were performed. Serum samples derived from healthy volunteers and the fetal bovine serum that is used regularly in cell culture experiments used as controls. Hospitalized Covid-19 patients who had also cancer, were retrospectively screened, and their clinical course were recorded. Overall 12 Patient (PS) and 4 healthy serums (CS) were included in the experiments. PS applied cells showed increased motility in A549 cells as well as lost cell to cell connection in MCF7 and HCT116 cells, and induced expression of VIM, ZEB1 and SNAIL2 mRNA levels. Eight cancer diagnosed patients who were hospitalized due to Covid-19 between April and September 2020 were also reviewed retrospectively, which 5 of them were dead during SARS-CoV-2 infection. Thorax CT images of the 2 patients showed increased metastatic nodules in the lungs as of January 2021. The results of the study indicate that metastasis may be one of the prolonged consequences of COVID-19 pandemic in cancer sufferers.

Commissioning and quality assurance of Euromechanics add-on multileaf collimator

In this study, the beam characteristics of a Euromechanics add-on MLC that has been installed on a Varian CLINAC 2100 C/D linear accelerator are presented. This was the first installation of 60-leaf PMLC from Euromechanics Company worldwide and all mechanical and dosimetric parameters were measured before clinical use of this kind of MLC. Mechanical tests were executed for different gantry and collimator angles. Leaf position accuracy and leaf gap reproducibility were checked with four different tests. The leaf transmissions, collimator (Sc), phantom (Sp), total (Sc,p) scatter factors, output of the machine, beam profiles for off-axis ratios, central axis depth dose, flatness, symmetry and penumbra have been measured for different field sizes pre and post MLC installation in 6 and 18 MV-mode. To evaluate the effect of new data on clinical plans, different beam setup configurations conformed with MLC and custom blocks were planned on CT images of thorax a CIRS phantom model 002LFC in the same treatment planning system. Leaf position in picket fence test found to be in range between 4.89–5.02 cm instead of nominal 5 cm, however the results of this test with EPIDs image and PIPSpro software showed the higher deviation rather than the results reported from the tests with EBT3 films. The measured data showed that on average Sc,p and Sc were increased 0.22% (P = 0.86) and 0.34% (P = 0.86) for 6 MV and 0.37% (P = 0.84) and 0.42% (P = 0.88) for 18 MV beams for different field sizes, respectively. Good agreement was observed between the PDD and profile curves pre and post MLC installation that was expected based on no changes in beam energy and geometry of the collimators. Based on the mechanical and dosimetry results which have been achieved from our different standard tests, it was found no significant differences between pre and post MLC installation values. This indicates, installation and using this system is clinically acceptable.

Serum biomarkers in patients with stable and exacerbated COPD-bronchiectasis overlap syndrome.

Bronchiectasis (B), commonly seen in patients with chronic obstructive pulmonary disease (COPD), is associated with exacerbations and predicts mortality. To differentiate patient groups with COPD-(B+) or COPD-(B-) and their exacerbations by using inflammatory markers. Consecutive COPD patients were divided into two groups according to findings on high resolution thorax CT (HRCT) images using Smith and modified Reiff scores. Patients were prospectively followed for possible future exacerbations. Serum fibrinogen, C-reactive protein (CRP), soluble urokinase-type plasminogen activator receptor (suPAR) and Plasminogen activator inhibitor-1 (PAI-1) levels were studied during exacerbation and stable periods. Eighty-seven patients were included and (85M, 2 F), mean aged was 68.1±9 (46-87). HRCT confirmed bronchiectasis in 38 (43.7%) patients, most commonly in tubular form (89.4%) and in lower lobes. COPD-B(+) group had lower body mass index (P=0.036), more advanced stage of disease (P=0.004) and more frequent exacerbation (P=0.01). The HRCT scores were correlated with exacerbation rate (r=0.356, P<0.05). Fibrinogen and CRP values were higher in exacerbation (P= 0.01, P= 0.013, respectively) especially in COPD-B(+) patients. suPAR and PAI-1 levels were also higher in COPD-B(+) patients although it was not statistically significant. Bronchiectasis is common and causes frequent exacerbations in COPD. Identifying of COPD-B(+) phenotype by HRCT scoring systems has considerable importance for both therapeutic options and clinical outcome of the disease. In addition to fibrinogen and CRP, high serum levels of suPAR and PAI-1 suggest us their significant roles in increased systemic inflammation associated with coexisting of COPD and bronchiectasis.

Prevelance of the costal cartilage fracture on the computerised tomography in chest trauma.

Radiography remains limited in costal cartilage injuries, and sonography, CT and MR imaging turns out to be more sensitive in the detection of cartilage injuries. This study aims to determine the frequency of costal cartilage fractures detected in the CT images of the patients with high energy chest trauma and to evaluate the association of costal cartilage fracture with the complications of trauma. The CT images of 93 patients aged 18-91years with a trauma admitted to the Emergency Department of the State Hospital between February 2019 and June 2019 were studied retrospectively. Thorax CT images of 93 patients who presented to the emergency department with blunt chest trauma with AIS > 2 were retrospectively investigated by a radiologist with a board certificate who had 15years of experience in the field. Costal cartilage fracture was identified in 39 of 93 patients with severe chest trauma. Among the 93 chest trauma patients admitted to the emergency department between February and June 2019, the prevalence of costal cartilage was calculated as 41.93%. Note that the most common costal cartilage fractures in the study group were identified in the 6th, 7th, 8th and 1st costal cartilages. Another significant relationship (p = 0.007) was found between costal cartilage calcification and cartilage fracture. Costal cartilage fractures frequently occur in blunt thoracic trauma with multiple rib fractures and are of clinical importance as they lead to the instability of chest wall. The incidence of cartilage fractures increases in elderly patients with costal cartilage calcification.

Systemic air embolism depicted on systematic whole thoracic CT acquisition after percutaneous lung biopsy: Incidence and risk factors

ObjectivesTo evaluate the incidence and risk factors of systemic air embolism (SAE) depicted on systematic whole thoracic CT performed after percutaneous lung biopsy. MethodsA total of 559 CT-guided lung biopsies performed between April 2014 and May 2016 were retrospectively evaluated. SAE was defined by the presence of air in the aorta or left cardiac cavities seen on whole thorax CT images acquired after needle withdrawal. Analyzed data focused on patient (age, sex, spirometry data, emphysema on CT, therapeutics received), target lesion (location, depth, size and feature) and procedure (patient position, length of intrapulmonary needle path, number of pleural passes and of biopsy samples, operator’s experience). A regression logistic model was used to identify risk factors of SAE. ResultsSAE was observed after 27 of the 559 lung biopsies, corresponding to a radiological incidence of 4.8% (95%CI: 3.3–7.0). Clinical incidence was 0.17% (n = 1). For 21/27 patients (78%), a targeted acquisition in the nodule area would not have included the cardiac cavities meaning SAE would have been missed. On multivariate analysis, the independent risk factors were needle path length through ventilated lung (OR: 1.13, 95%CI: 1.02–1.25, p = 0.024), number of samples (OR: 1.48, 95%CI: 1.01–2.17, p = 0.046) and prone position (OR: 3.12, 95%CI: 1.11–8.31, p = 0.031) or right-sided lateral decubitus (OR: 6.15, 95%CI: 1.66–22.85, p = 0.005). ConclusionsAsymptomatic systemic air embolism can be depicted in almost 5% of post biopsy CT examinations, when they are not limited to the targeted nodule area but include the entire thorax.

310. A radiomics analysis process using free software platforms: Our experience in Sassari

Purpose Radiomics have proved to be useful in exploiting imaging data to correlate and even predict some phenotypic or genetic tumor characteristics. Our purpose was to build and test a complete radiomic analysis process, mainly addressed to CT imaging of thoracic district, using a 3D-Slicer platform (mainly promoted by NIH) and R computing and graphic software (international R-core team). Methods and materials 3D-Slicer free software (v.4.6 and 4.7) was installed on a 32 GB-RAM workstation, equipped with two diagnostic quality 3MP monitors. Lesions’ outlining exploited the semi-automatic 3D-Slicer contouring tool Fast-GrowCut. Plastimatch and Radiomics modules were used, respectively, for images elastic registration (among CT scans with and without contrast agent) and for 94 radiomic features determination (first order, shape, GLCM, GLRLM, GLSZM). The full process was tested on 21 patients, all affected by NSCLC, scanned by the same tomograph. Features were assessed only on non-enhanced images. An in-house R script was built to evaluate the main statistical indices and some graphical results on the test group. Results 3D-Slicer free platform has proved an excellent one for accurate lesions’ delineation on thorax CT images, thanks to the Fast-GrowCut tool which has high performances in the presence of high HU contrast. The elastic fusion transformation matrix (Plastimatch) helped to better define the tumor contour, excluding atelectasis or border regions in some unclear cases, if the correspondent enhanced scan was available. Radiomics tool (3D-Slicer option by Pyradiomics), combined with the in-house R routine, permitted to evaluate intensive and exstensive radiomic features, together with their densities when meaningful (e.g. entropy), to evaluate their distribution and prepare for radiomic fingerprint maps and cluster analysis. Conclusion Our works has built a free of charge complete radiomics process, based on internationally validated softwares, to contour lesions and assess radiomic features, features densities and statistical analysis on patients’ groups.

Comparison of volumetric breast density estimations from mammography and thorax CT

Breast density has become an important issue in current breast cancer screening, both as a recognized risk factor for breast cancer and by decreasing screening efficiency by the masking effect. Different qualitative and quantitative methods have been proposed to evaluate area-based breast density and volumetric breast density (VBD). We propose a validation method comparing the computation of VBD obtained from digital mammographic images (VBDMX) with the computation of VBD from thorax CT images (VBDCT). We computed VBDMX by applying a conversion function to the pixel values in the mammographic images, based on models determined from images of breast equivalent material. VBDCT is computed from the average Hounsfield Unit (HU) over the manually delineated breast volume in the CT images. This average HU is then compared to the HU of adipose and fibroglandular tissues from patient images. The VBDMX method was applied to 663 mammographic patient images taken on two Siemens Inspiration (hospL) and one GE Senographe Essential (hospJ). For the comparison study, we collected images from patients who had a thorax CT and a mammography screening exam within the same year. In total, thorax CT images corresponding to 40 breasts (hospL) and 47 breasts (hospJ) were retrieved. Averaged over the 663 mammographic images the median VBDMX was 14.7% . The density distribution and the inverse correlation between VBDMX and breast thickness were found as expected. The average difference between VBDMX and VBDCT is smaller for hospJ (4%) than for hospL (10%). This study shows the possibility to compare VBDMX with the VBD from thorax CT exams, without additional examinations. In spite of the limitations caused by poorly defined breast limits, the calibration of mammographic images to local VBD provides opportunities for further quantitative evaluations.

Incidental CT Findings of Patients Who Admitted to ER Following a Traffic Accident

SUMMARYObjectiveThe aim of this study was to investigate and analyze incidental CT findings of traffic injury patients discharged from the ER, and to determine overall notification rates.MethodsAll traffic injury-related patient records between 01.06.2013–01.03.2013 were obtained from Derince Training and Research Hospital Emergency Service using patient files and the hospital database. Brain, thorax and/or abdominal CT images of 340 patients aged between 0 to 84 years were included in the study. ER observation forms were investigated for the patients who had incidental findings on CT scanning and overall notification rates were recorded.ResultsMean age of the 363 cases was 31.2 (SD 17.9, min 0, max 84) and 35.5% of patients were female (n=129) and 64.5% were male (n=234). A total of 537 CT scans were performed on 363 patients. 147, 319 and 71 CT scans were performed on the thorax, brain and abdominal, respectively. 27.3% (n=99) of scan results showed the presence of a coincidental pathology. The most common disease on scans were bone lesions (8%, n=29), followed by sinus abnormalities (7.7%, n=28). Incidental findings ratio in patients aged over 60 was 60.8%, while under 60 was 24.8%. It was found that seven patients (7.1%) were informed about the imaging results.ConclusionMost of the incidental findings were found to be benign; however, 16.5% of them were considered to require in-depth investigation. Further investigations are needed to understand the clinical relevance of these findings and their effects on patients.

A diagnostic dilemma in AL(L)PS

Dear Editor, An 18-month-old female infant presented to the paediatric haematology service in 1985 with lymphadenopathy, hepatosplenomegaly, anaemia (Hb 6.3 g/dL, range 11.7– 14 g/dL) and thrombocytopenia (17×10, range 150– 400×10). Bone marrow and lymph node examinations were reported as ‘reactive’. Karyotyping was normal. Viral, autoimmune and metabolic screens were negative. Following a period of observation and external review, during which time her marrow blast count rose to 9 %, the decision was made to proceed with Medical Research Council protocol for acute lymphoblastic leukaemia, with complete normalisation of peripheral blood counts and regression of spleen size for the duration of treatment (1986–1988). Her subsequent disease course included recurrent sinus and respiratory tract infections, fluctuating cytopenias, chronic lymphadenopathy and an elective splenectomy in the setting of massive splenomegaly. She developed severe autoimmune haemolytic anaemia, requiring intense immunosuppression and ultimately plasma exchange followed by recurrent invasive pneumococcal septicaemia on ages 14, 16 and 18 years. She was referred for immunological assessment in 2009 when a biopsy of an epitrochlear lymph node revealed paracortical T cell zone expansion with evidence of clonal T cell rearrangements, subsequently confirmed on bone marrow biopsy. CT images of thorax, abdomen and pelvis showed no evidence of lymphoma. On review, it emerged that her father, paternal aunt and first cousin all had a previous diagnosis of lymphoma. Screening for autoimmune lymphoproliferative syndrome (ALPS) confirmed the presence of double negative (DN) αβT cells (18 %, normal<1.5%) andFasL 1.5 ng/mL (normal range<0.2 ng/mL). Genetic testing demonstrated heterozygous nonsense mutation in exon 9 of the Fas gene confirming the diagnosis. Her father was found to have the same mutation. She failed to respond to the meningococcal vaccine and to both conjugated and unconjugated pneumococcal vaccines. She had a low IgG (IgG 4.6, range 6–15 g/L) and absent IgG2 with an elevated IgA (IgA 5.65, range 0.7–4.0 g/L) and normal IgM (IgM 1.0, range 0.5–2.3 g/L). Hypogammaglobulinaemia, recurring infection and failure to respond to vaccination is consistent with common variable immune deficiency which has been reported in association with ALPS [1]. At age 28, she presented with left hand and forearm swelling following minor trauma. C4 was undetectable (<0.0167 g/L, range 0.14–0.54 g/L). Both C3 and C1 inhibitor levels were reduced at 0.55 g/L (range 0.75–1.65 g/L) and 0.38 mg/L (range 150–350 mg/L), respectively. C1q levels were 44 mg/L (normal range 50– 250 mg/L). Based on the history, reduced C4, C1 inhibitor and C1q levels, a diagnosis of acquired C1 inhibitor deficiency was made. The diagnostic criteria for ALPS are elevated CD3 TCRαβ CD4 CD8 DNT cells ≥1.5 % of the total lymphocytes along with chronic non-malignant, non-infectious C. Lee-Brennan :M. Keogan Department of Immunology, Beaumont Hospital, Beaumont, Dublin 9, Ireland

Automatic Segmentation of Connected Thin Peripheral Vessels in Chest CT Scan Images

Vessel enhancement and segmentation is one of the crucial pre-processing steps in accurate vessel tree reconstruction in many chest CT scan imaging applications. Conservative vessel enhancement approaches used eigenvalues of Hessianbased filters, which are found to be sensitive to noise, fails to detect small ones, and sometimes give discontinued vessels due to junction suppression. Since Hessian-based filters cannot distinguish step edges from vessels effectively, in this paper, we propose a novel framework to overcome the problems for vessel enhancement for thorax CT images. The road map of proposed work has three steps. First, extract the lung region from thorax CT images based on Gray-level thresholding and morphological operations; then, according to the idea of the matched filter in different directions, and local entropy thresholding, to obtain more precise analysis in noisy environment and thus can correctly reveal entire vessels. Also, qualitative as well as quantitative evaluations performed on CT images show that the proposed filter generates better performance in comparison against two Hessian-based approaches (Frangi and Shikata)..